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Mendoza-Jiménez MJ, van Exel J, Brouwer W. On spillovers in economic evaluations: definition, mapping review and research agenda. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1239-1260. [PMID: 38261132 PMCID: PMC11377364 DOI: 10.1007/s10198-023-01658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
An important issue in economic evaluations is determining whether all relevant impacts are considered, given the perspective chosen for the analysis. Acknowledging that patients are not isolated individuals has important implications in this context. Increasingly, the term "spillovers" is used to label consequences of health interventions on others. However, a clear definition of spillovers is lacking, and as a result, the scope of the concept remains unclear. In this study, we aim to clarify the concept of spillovers by proposing a definition applicable in health economic evaluations. To illustrate the implications of this definition, we highlight the diversity of potential spillovers through an expanded impact inventory and conduct a mapping review that outlines the evidence base for the different types of spillovers. In the context of economic evaluations of health interventions, we define spillovers as all impacts from an intervention on all parties or entities other than the users of the intervention under evaluation. This definition encompasses a broader range of potential costs and effects, beyond informal caregivers and family members. The expanded impact inventory enables a systematic approach to identifying broader impacts of health interventions. The mapping review shows that the relevance of different types of spillovers is context-specific. Some spillovers are regularly included in economic evaluations, although not always recognised as such, while others are not. A consistent use of the term "spillovers", improved measurement of these costs and effects, and increased transparency in reporting them are still necessary. To that end, we propose a research agenda.
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Affiliation(s)
- María J Mendoza-Jiménez
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Facultad de Ciencias Sociales y Humanísticas, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador.
| | - Job van Exel
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Nam SM, Park HY, Kim MJ. Exploring the experiences of dancers who have achieved peak performance: on-stage, pre-stage, and post-stage. Front Psychol 2024; 15:1392242. [PMID: 38855308 PMCID: PMC11162116 DOI: 10.3389/fpsyg.2024.1392242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/01/2024] [Indexed: 06/11/2024] Open
Abstract
The aim of this study is to identify and classify the different attributes that contribute to peak performance among professional dancers, and to understand how these attributes change over time. We conducted an analysis using inductive content analysis on open-ended survey data collected from 42 formally trained professional dancers. Additionally, we analyzed interview data from seven professional dancers who demonstrated outstanding achievements in the field among the survey participants. The main themes that emerged were related to various temporal events of peak performance experience: pre-stage, on-stage, and post-stage. During the on-stage, peak performance was perceived by both internal and external factors. During the pre-stage, emphasis was placed on technical, cognitive, and artistic strategies during practice, whereas just before going on the stage, attention shifted to psychological and physical strategies. During the post-stage, dancers reported immediate changes in their psychological and physical states following the peak performance experience, and thereafter, the peak performance experience was noted to influence psychological, technical, and cognitive aspects. These findings provide valuable insights into the key characteristics that emerge throughout a series of peak performance experiences and are consistent with previous research.
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Affiliation(s)
- Soo Mi Nam
- Division of Sports Science, Hanyang University, Ansan, Republic of Korea
| | - Hye Youn Park
- Institute of Sports Science, Seoul National University, Seoul, Republic of Korea
| | - Min Joo Kim
- Division of Sports and Exercise Science, Kunsan National University, Gunsan-si, Republic of Korea
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Lathe J, Silverwood RJ, Hughes AD, Patalay P. Examining how well economic evaluations capture the value of mental health. Lancet Psychiatry 2024; 11:221-230. [PMID: 38281493 DOI: 10.1016/s2215-0366(23)00436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
Health economics evidence informs health-care decision making, but the field has historically paid insufficient attention to mental health. Economic evaluations in health should define an appropriate scope for benefits and costs and how to value them. This Health Policy provides an overview of these processes and considers to what extent they capture the value of mental health. We suggest that although current practices are both transparent and justifiable, they have distinct limitations from the perspective of mental health. Most social value judgements, such as the exclusion of interindividual outcomes and intersectoral costs, diminish the value of improving mental health, and this reduction in value might be disproportionate compared with other types of health. Economic analyses might have disadvantaged interventions that improve mental health compared with physical health, but research is required to test the size of such differential effects and any subsequent effect on decision-making systems such as health technology assessment systems. Collaboration between health economics and the mental health sciences is crucial for achieving mental-physical health parity in evaluative frameworks and, ultimately, improving population mental health.
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Affiliation(s)
- James Lathe
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK.
| | - Richard J Silverwood
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
| | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, Faculty of Population Health Sciences, University College London, London, UK; Centre for Longitudinal Studies, Social Research Institute, Institute of Education, Faculty of Education and Society, University College London, London, UK
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Elliott J, Francetic I, Meacock R, Sutton M. Do Informal Care Recipients Internalise Carer Burden? Examining the Impact of Informal Care Receipt on Health Behaviours. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:209-225. [PMID: 38198104 PMCID: PMC10864417 DOI: 10.1007/s40258-023-00843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Providing informal care has a negative effect on the caregiver's health and well-being, but little is known about how individuals respond to receiving informal care. Care recipients may improve their health behaviours to minimise the onerousness of caregiving and the stress faced by their carer from seeing a loved one in ill-health. OBJECTIVE We aimed to examine whether informal care recipients internalise the potential for carer spillovers through changes in health behaviours. METHODS We used data from 3250 older adults with care needs who took part in the UK Household Longitudinal Study between 2017 and 2019. We examined the response to informal care receipt in terms of the probability of engaging in four health behaviours: healthy diet, physical activity, smoking and alcohol consumption. We estimated average treatment effects using regression adjustment with inverse probability treatment weights, comparing individuals that received informal care to those receiving either formal or no care. RESULTS We found that informal care receipt increased the probability of refraining from negative health behaviours (smoking and alcohol consumption) but reduced the probability of engaging in positive health behaviours (eating fruits and/or vegetables and physical activity). CONCLUSIONS The asymmetric effects detected suggest that the underlying mechanisms are different, and care recipients may be engaging in risk and effort compensation between negative and positive health behaviours. Failure to account for the behavioural responses from informal care recipients may lead to under-estimation or over-estimation of the extent of caregiving burden and the effectiveness of interventions impacting informal carers.
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Affiliation(s)
- Jack Elliott
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK.
| | - Igor Francetic
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK
| | - Rachel Meacock
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Services, The University of Manchester, Williamson building, 176 Oxford Road, Manchester, M13 9QQ, UK
- Melbourne Institute, Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia
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Kumar R, Fu J, Ortiz BL, Cao X, Shedden K, Choi SW. Dyadic and Individual Variation in 24-Hour Heart Rates of Cancer Patients and Their Caregivers. Bioengineering (Basel) 2024; 11:95. [PMID: 38247972 PMCID: PMC10813060 DOI: 10.3390/bioengineering11010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Twenty-four-hour heart rate (HR) integrates multiple physiological and psychological systems related to health and well-being, and can be continuously monitored in high temporal resolution over several days with wearable HR monitors. Using HR data from two independent datasets of cancer patients and their caregivers, we aimed to identify dyadic and individual patterns of 24 h HR variation and assess their relationship to demographic, environmental, psychological, and clinical variables of interest. METHODS a novel regularized approach to high-dimensional canonical correlation analysis (CCA) was used to identify factors reflecting dyadic and individual variation in the 24 h (circadian) HR trajectories of 430 people in 215 dyads, then regression analysis was used to relate these patterns to explanatory variables. RESULTS Four distinct factors of dyadic covariation in circadian HR were found, contributing approximately 7% to overall circadian HR variation. These factors, along with non-dyadic factors reflecting individual variation exhibited diverse and statistically robust patterns of association with explanatory variables of interest. CONCLUSIONS Both dyadic and individual anomalies are present in the 24 h HR patterns of cancer patients and their caregivers. These patterns are largely synchronous, and their presence robustly associates with multiple explanatory variables. One notable finding is that higher mood scores in cancer patients correspond to an earlier HR nadir in the morning and higher HR during the afternoon.
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Affiliation(s)
- Rajnish Kumar
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA; (R.K.); (B.L.O.); (X.C.)
| | - Junhan Fu
- Department of Statistics, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI 48109, USA; (J.F.); (K.S.)
| | - Bengie L. Ortiz
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA; (R.K.); (B.L.O.); (X.C.)
| | - Xiao Cao
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA; (R.K.); (B.L.O.); (X.C.)
| | - Kerby Shedden
- Department of Statistics, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI 48109, USA; (J.F.); (K.S.)
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA; (R.K.); (B.L.O.); (X.C.)
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Newcombe PA, Chang AB. Clinical determinants for State-Trait Anxiety Inventory of the parents of children with respiratory problems. Pediatr Pulmonol 2024; 59:31-40. [PMID: 37750592 PMCID: PMC10952396 DOI: 10.1002/ppul.26702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUNDS Understanding factors associated with anxiety of parents/carers of children with respiratory problems is clinically important yet there is relative paucity of data. In 106 children seen in the respiratory clinic of a pediatric hospital, we evaluated (a) the determinants for parental anxiety and (b) whether the anxiety scores correlate with quality-of-life (QoL) scores in the subset with chronic cough. METHODS We opportunistically re-analyzed data of our main study that examined the benefits of using spirometry for pediatric respiratory consultation where parents completed an anxiety questionnaire (State-Trait Anxiety Inventory, STAI) pre- and postconsultation. A subset (children with chronic cough) also completed the parent-proxy quality-of-life (PC-QoL) tool. We computed the association between clinical characteristics and anxiety scores using multivariable regression and between the two patient-reported outcome measures using Spearman's correlation. RESULTS The majority of parents/carers were women (n = 89, 84%). Most children (mean age = 10.9 years, SD = 3.7 years) were previously seen at the clinic (n = 67, 63.2%). In multivariate regression, parental anxiety score was significantly associated with reported presence of cough [coefficient β = 17.31 (95% confidence interval 9.62, 25.1)] and lower forced expiratory volume in first second (FEV1 )/forced vital capacity (FVC) [-3.88 (-7.05, -0.71)] at preconsultation, but associated with cough only [coefficient β = 12.04 (5.24, 18.84)] at postconsultation, all p < .05. STAI strongly correlated with PC-QoL scores at pre- but only modestly at postconsultation (rs = -.63 and -.39, respectively, p < .05). CONCLUSION Parental anxiety levels of children attending respiratory clinics are influenced by the presence of cough and low FEV1 /FVC of their child and are associated with poorer QoL. These highlight the need for on-going research to reduce parental anxiety focusing on cough and lung function indices.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Julie M. Marchant
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Margaret S. McElrea
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Stephanie T. Yerkovich
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Peter A. Newcombe
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
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Spencer CM, Keilholtz BM, Palmer M, Vail SL. Mental and Physical Health Correlates for Emotional Intimate Partner Violence Perpetration and Victimization: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:41-53. [PMID: 36458866 DOI: 10.1177/15248380221137686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Approximately 50% of both men and women will experience emotional intimate partner violence (IPV) in their lifetime-a form of violence highly associated with other forms of IPV-making it important to develop further understanding of for assessment and treatment purposes. The bio-psycho-social model was used to guide the study. Utilizing data from 181 studies, yielding 348 effect sizes, we conducted a meta-analysis examining mental and physical health correlates with emotional IPV perpetration and victimization. We also examined if mental and physical health correlates were significantly stronger for emotional IPV perpetration or victimization, as well as if correlates were stronger for men or women. Suicidal ideation, post-traumatic stress, anxiety, depressive symptoms, borderline personality disorder (PD), psychological distress, physical pain, trauma, anger, shame, poor physical health, antisocial PD, and somatic symptoms were significantly associated with emotional IPV victimization. Borderline PD, narcissism, emotional dysregulation, anger, post-traumatic stress, antisocial PD, psychopathy, depressive symptoms, anxiety symptoms, and trauma were significantly associated with emotional IPV perpetration. Anger, emotional dysregulation, and psychopathology were stronger correlates for emotional IPV perpetration compared to victimization, and post-traumatic stress disorder (PTSD) and psychological distress were stronger correlates for victimization. PTSD and suicidal ideation were stronger correlates of IPV victimization for women than men, and anger was a significantly stronger correlate of IPV perpetration for women than men. This study highlights the importance of a holistic approach when working with victims and perpetrators of IPV, focusing on the importance of taking all aspects of the bio-psycho-social model into account.
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Alawi S, Dieperink KB, Agerskov H, Marcussen J, Möller S, Voltelen B, Hyldig N. Translation and Cross-Cultural Validation of the Danish Version of the Family Health Scale-Long Form: A Psychometric Study. Semin Oncol Nurs 2023; 39:151480. [PMID: 37550098 DOI: 10.1016/j.soncn.2023.151480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The Family Health Scale is a new instrument for evaluating family health. The instrument is reported as valid and reliable in investigating family health among different types of adult family members. This study aimed to translate the Family Health Scale into Danish and investigate its validity and reliability in families with a family member affected by chronic or serious illness. DATA SOURCES Translation was performed through forward and backward bilingual practice consisting of 10 steps. A cross-sectional study included 406 participants, of whom 94 also participated in a follow-up study within 3 weeks for the test-retest. Content validity was examined by conducting cognitive interviews with nine family members. Internal consistency reliability was assessed using Cronbach α. The test-retest reliability was evaluated using intraclass correlation coefficients. Model fit was assessed using confirmatory factor analysis. CONCLUSION The Family Health Scale demonstrated good content validity and a moderate model fit. Both Internal consistency reliability and test-retest reliability were satisfying. Cronbach α ranged from 0.73 to 0.89, while the intraclass correlation coefficient value was 0.88. The confirmatory factor analysis estimated a satisfying model fit, with an acceptable root-mean-square error of 0.076 and a moderate comparative fit index of 0.794. IMPLICATION FOR NURSING PRACTICE The Family Health Scale instrument has the potential to identify vulnerable families or families affected by chronic or serious illnesses, such as cancer. The assessment tool can consequently be used to target interventions to promote family health and improve the health of both the individual and his/her family.
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Affiliation(s)
- Sharifa Alawi
- Department of Oncology, Research Unit of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Family Focused Healthcare Research Center (FaCe), University of Southern Denmark, Odense, Denmark.
| | - Karin B Dieperink
- Department of Oncology, Research Unit of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Jette Marcussen
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Health Sciences, University College Lillebaelt, Vejle, Denmark; Department of Nature and Health, University of Greenland
| | - Sören Möller
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Barbara Voltelen
- Department of Clinical Research, FaCe, University of Southern Denmark, Odense, Denmark; Department of Nursing Education and Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Nana Hyldig
- Department of Haematology, Research Unit of Haematology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Ward AL, McPherson L, Mc Glanaghy E. Discussion Surrounding Theory, Knowledge, and Practical Applications for Clinical Nurse Specialists to Aid Them in Caring for Parents with Cancer Who Have Young Children. Semin Oncol Nurs 2023; 39:151483. [PMID: 37567835 DOI: 10.1016/j.soncn.2023.151483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To identify the theory, knowledge, and practical applications that clinical nurse specialists should consider adding to their "toolkit" to support them in caring for people affected by cancer with young children. DATA SOURCES Expert opinion and relevant studies on the topic formed the basis of this article. CONCLUSION A conversation with experts identified five key areas of knowledge important to supporting clinical nurse specialists in caring for people affected by cancer with young children: family-centered and systemic practice, nursing responsibilities and competencies, trauma-informed practice, adult life stages, and stages of child development. Key areas identified have relevance to all healthcare professionals working in cancer care. IMPLICATIONS FOR NURSING PRACTICE This article provides a useful overview of psychological theories important to supporting healthcare professionals in caring for people affected by cancer. A discussion on the boundaries and competencies of the nursing role led to agreement about practical advice rooted in theory and knowledge that could benefit clinical practice. Concepts of emotional labor and the wounded healer were identified as important to inform reflection and supervision when caring for a parent affected by cancer who has a young family.
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Affiliation(s)
- Ashleigh Lauren Ward
- Consultant Nurse Cancer and Palliative Care, Directorate of Nursing, NHS Forth Valley, Stirling, UK; Honorary Clinical Senior Lecturer, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - Lorraine McPherson
- Cancer and Palliative Care Facilitator, Directorate of Nursing, NHS Forth Valley, Stirling, UK
| | - Edel Mc Glanaghy
- Clinical Psychologist, Adult Psychological Therapies, NHS Forth Valley, Falkirk Community Hospital, Falkirk, UK
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Wilkin T, Stott A, Lin JL, Pate J, McEwen A, Verhagen A, Turbitt E. Free Online Decision Tools to Support Parents Making Decisions About Their Children's Chronic Health Condition: An Environmental Scan. Acad Pediatr 2023; 23:874-883. [PMID: 36775123 PMCID: PMC11047007 DOI: 10.1016/j.acap.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Medical decisions parents make on their children's behalf can be challenging. Free online decision support tools are created to help parents faced with these decisions. OBJECTIVE We used an environmental scan to identify free, online tools that support parents in making decisions about their children's chronic health condition. We described the tools and assessed their potential to harm, content, development process, readability, and whether their use changed decision makers' knowledge and alignment of their preferences with their final decision. DATA SOURCES AND ELIGIBILITY Decision aid repositories, Google searches, and key informants identified decision support tools. Eligible tools were freely available online and for parents of children with chronic health conditions. APPRAISAL METHODS Two reviewers independently assessed the tools' quality based on the International Patient Decision Aid Standards (IPDAS). Tool readability was assessed using the Flesch Reading Ease test. RESULTS From 21 free, online decision support tools, 14 (67%) provided sufficient detail for making a specific decision (IPDAS qualifying criteria). None sufficiently met IPDAS certification criteria necessary to reduce the possibility of patient harms when using the tool. Three (14%) were fairly easy or easy to read. Of those evaluated by developers (n = 6), 2 improved knowledge and 4 improved alignment of preferences with the available options. LIMITATIONS Google searches and key informant sources are not replicable. CONCLUSIONS Free, online decision support tools for parents of children with chronic health conditions are of variable quality, most are difficult to read, and there is limited evidence their use achieves intended outcomes. REGISTRATION NUMBER Registered with Open Science Framework 20 July 2021(AEST) osf.io/b94yj.
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Affiliation(s)
- Tessa Wilkin
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia
| | - Ami Stott
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia
| | - Jody L Lin
- Department of Pediatrics, University of Utah Health (JL Lin), Salt Lake City, Utah
| | - Joshua Pate
- Discipline of Physiotherapy, University of Technology Sydney (J Pate and A Verhagen), Ultimo, NSW, Australia
| | - Alison McEwen
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia
| | - Arianne Verhagen
- Discipline of Physiotherapy, University of Technology Sydney (J Pate and A Verhagen), Ultimo, NSW, Australia
| | - Erin Turbitt
- Discipline of Genetic Counselling, University of Technology Sydney (T Wilkin, A Stott, A McEwen, and E Turbitt), Ultimo, NSW, Australia.
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Valladares-Garrido MJ, Picón-Reátegui CK, Zila-Velasque JP, Grados-Espinoza P, Vera-Ponce VJ, Pereira-Victorio CJ, Valladares-Garrido D, Failoc-Rojas VE. Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study. BMC Public Health 2023; 23:691. [PMID: 37055833 PMCID: PMC10100618 DOI: 10.1186/s12889-023-15612-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel. METHODS We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments. RESULTS We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43). CONCLUSION We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.
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Affiliation(s)
- Mario J. Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo, Peru
| | | | - J. Pierre Zila-Velasque
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Pamela Grados-Espinoza
- Facultad de Medicina Humana, Universidad Nacional Daniel Alcides Carrión, Pasco, Peru
- Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Víctor J. Vera-Ponce
- Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, 15039 Peru
- Universidad Tecnológica del Perú, Lima, 15046 Peru
| | | | - Danai Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura, Peru
- Unidad de Epidemiología y Salud Ambiental, Hospital de Apoyo II Santa Rosa, Piura, Peru
| | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima, Peru
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12
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Sar BK. Refugee Family Health Brokers' (FHBs') Experiences with Health Care Providers: A Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5381. [PMID: 37047995 PMCID: PMC10094286 DOI: 10.3390/ijerph20075381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/24/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The resettlement and post-resettlement quality of life of refugees is often marred by chronic health/mental health conditions. To adequately care for refugees suffering these conditions, a promising strategy is the use of refugee Family Health Brokers (FHBs). FHBs are safe and trusted family members functioning as intermediaries between one's family and health care providers. Although FHBs are known to positively influence health care utilization in their families, little is known about them and this aspect of their family caregiving role and experiences, particularly with health care providers, necessitating further research. METHODS Fourteen Bhutanese and three Bosnian refugee FHBs participated in a 2-hr focus group discussing their experiences with health care providers after being surveyed about their FHB role. RESULTS Thematic analysis yielded five themes centered around perceptions, knowledge, communication, behavior, and responsibilities reflective of FHBs' experiences, which can be understood as symptoms of existing structural inequalities. CONCLUSIONS FHBs primarily conveyed problems, struggles, and dilemmas they experienced more so than rewarding aspects of being an FHB. Suggestions are provided on how to avert these negative experiences from occurring and becoming barriers to developing allyship with FHBs in the context of existing structural inequalities.
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Affiliation(s)
- Bibhuti K Sar
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY 40208, USA
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13
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Wiegand-Grefe S, Warkentin H, Adema B, Daubmann A, Kilian R, Winter SM, Lambert M, Wegscheider K, Busmann M. Families with Mentally Ill Parents and Their Partners: Overlaps in Psychiatric Symptoms and Symptom Coping. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5240. [PMID: 37047856 PMCID: PMC10094103 DOI: 10.3390/ijerph20075240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Partners in families with a mentally ill parent often experience psychiatric symptoms themselves. Recent studies indicate that there might be overlaps in disorder-specific symptom areas between partners and spouses. This study aimed at examining associations in psychiatric symptoms and symptom coping in partners in families with a mentally ill parent, e.g., having a psychiatric diagnosis according to the International Classification of Diseases (ICD-10). Furthermore, a moderation of the psychiatric symptoms of the parent with a mental illness on the association in symptom coping was assumed. Families with at least one parent with a mental illness were recruited into the longitudinal "Children of Mentally Ill Parents" (CHIMPS) trial at seven clinical centers in Germany and Switzerland. In total, 139 families were included in the current study. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI), Clinical Global Impression scale (CGI), Global Assessment of Functioning (GAF), and Patient Health Questionnaire (PHQ), while symptom coping strategies were measured using the Freiburger Fragebogen zur Krankheitsverarbeitung (FKV). Regression analyses have indicated an association in psychiatric symptoms between mentally ill parents and their partners concerning psychosocial functioning, somatic, and stress-related symptoms. Additionally, one symptom coping strategy of the partners was predicted by the same strategy of the parent with a mental illness. The results emphasize the importance of screening and providing support to parents burdened by the mental disorder of their partners, especially regarding the children in these partnerships.
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Affiliation(s)
- Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Hannah Warkentin
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Bonnie Adema
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Anne Daubmann
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, 89081 Ulm, Germany
| | - Sibylle M. Winter
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité University Medicine Berlin, 13353 Berlin, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Karl Wegscheider
- Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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14
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He L, Zheng Z, Li X, Cao X, Zhang J, Chen C, Lv Y, Wu C, Barry LC, Ying Z, Jiang X, Shi X, Liu Z. Association of spouse's health status with the onset of depressive symptoms in partner: Evidence from the China Health and Retirement Longitudinal Study. J Affect Disord 2023; 325:177-184. [PMID: 36603600 DOI: 10.1016/j.jad.2022.12.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/29/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the associations between the multidimensional health status of one spouse and the onset of depressive symptoms in partner, and whether the associations differed by gender and residence. METHODS We analyzed data from 2401 females and their husbands (scenario 1), and 2830 males and their wives (scenario 2) who participated in the 2011/2012 and 2015 waves of China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Multidimensional health indicators included mobility disability, activities of daily living disability, frailty, global cognition, depressive symptoms, comorbidity, and self-reported health. Principal component analysis was used to construct a composite health indicator reflecting overall health status that was then categorized into three groups (poor, moderate, and excellent). Logistic regression models were performed. RESULTS We observed strong associations of spouse's health status with the onset of depressive symptoms in partner. For instance, females whose husbands had poor overall health status reported more depressive symptoms than those having husbands with excellent overall health after four years (OR: 1.75; 95 % CI: 1.35, 2.26). These associations were statistically significant in rural females and urban males, but surprisingly disappeared in rural males and urban females. LIMITATIONS No exact timing of depressive symptoms onset. CONCLUSIONS In Chinese middle-aged and older adults, spouse's health status is associated with depressive symptoms in partner and the associations vary by gender and residence. The findings underscore the importance of considering partner's health status to manage one spouse's mental health.
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Affiliation(s)
- Liu He
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Zhoutao Zheng
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Xueqin Li
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Xingqi Cao
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Jingyun Zhang
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Yuebin Lv
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, Jiangsu 215316, China
| | - Lisa C Barry
- Department of Psychiatry, UCONN Health, CT 06030-1410, USA
| | - Zhimin Ying
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China.
| | - Xiaoyan Jiang
- Key Laboratory of Arrhythmias, Ministry of Education, Department of Pathology and Pathophysiology, School of Medicine, Tongji University, Shanghai 200092, China.
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China.
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15
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Jenkins C, Geisthardt C, Day JK. Supporting Children and Families in Medical Settings: Insights from Child Life Specialists During the COVID-19 Pandemic. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:1599-1616. [PMID: 36714377 PMCID: PMC9860232 DOI: 10.1007/s10826-023-02537-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 06/11/2023]
Abstract
Medical settings can be frightening and stressful places for pediatric patients and their families. During the COVID-19 pandemic fear and anxiety associated with receiving medical care increased as medical facilities dramatically altered the way they functioned in attempts to stop the spread of the virus. Certified Child Life Specialists (CCLSs) are medical professionals who provide psychosocial support for pediatric patients and their families by helping them understand and cope with medical procedures and the medical environment. In this role, CCLSs are likely to have important insights into the experiences and needs of pediatric patients and their families during COVID-19. Using a mixed-methods design, 101 CCLSs completed an online survey and 15 participated in follow-up interviews examining their experiences with and observations of children and families in medical environments during the pandemic. Participants emphasized a need to maintain a focus on child- and family-centered care for the well-being of patients and their families. While recognizing the need to socially distance to limit the spread of COVID, participants expressed concern about restrictive policies that did not balance the physical and mental health needs of patients and families. Participants also discussed the important role of child life services during the pandemic and the unique and multifaceted contributions CCLSs made to support patients, families, other medical professionals, and communities. Recommendations for supporting children and families in medical environments moving forward are discussed in light of lessons learned during the pandemic.
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Affiliation(s)
- Carly Jenkins
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
| | - Cheryl Geisthardt
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
| | - Jack K. Day
- Department of Human Development and Family Studies, Central Michigan University, 228 Education and Human Services, Mt. Pleasant, MI 48858 USA
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Haber L, Allen A, Rune KT. Sexual quality of life following a cancer diagnosis: a qualitative study. Support Care Cancer 2023; 31:125. [PMID: 36680658 PMCID: PMC9860240 DOI: 10.1007/s00520-022-07459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/28/2022] [Indexed: 01/22/2023]
Abstract
Sexual quality of life (SQoL) challenges are prevalent and persistent for people with a cancer diagnosis. Using a qualitative design, this study investigated the impact of a cancer diagnosis on SQoL in participants (N = 18) with a current or past cancer diagnosis of various sites and severity. Thematic analysis identified three themes: gender attachment, vulnerability, and growth vs. fixed mindset. The theme of gender attachment related to the impact of understanding SQoL based on heteronormative definitions of masculinity and femininity. The second theme of vulnerability suggested that pre-existing relational or personal challenges can amplify the impact of a cancer diagnosis on SQoL. The third theme of growth vs. fixed mindset explored how cognitive flexibility and optimism can support SQoL, while a rigid and pessimistic mindset can exacerbate SQoL challenges. The findings of this study build on the traditional medical understanding of SQoL and can inform SQoL support in cancer care settings.
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Affiliation(s)
- Lauren Haber
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Andrew Allen
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Karina T Rune
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia.
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17
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Naaktgeboren R, Zegers M, Peters M, Akkermans R, Peters H, van den Boogaard M, van de Laar FA. The impact of an intensive care unit admission on the health status of relatives of intensive care survivors: A prospective cohort study in primary care. Eur J Gen Pract 2022; 28:48-55. [PMID: 35388714 PMCID: PMC9004533 DOI: 10.1080/13814788.2022.2057947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Relatives of intensive care unit (ICU) survivors may suffer from various symptoms after ICU admittance of their relative, known as post-intensive care syndrome-family (PICS-F). Studies regarding PICS-F have been performed but its impact in primary care is unknown. Objectives To explore health problems of relatives of ICU survivors in primary care. Methods This is an exploratory prospective cohort study in which we combined data from two hospitals and a primary care research network in the Netherlands. ICU survivors who had been admitted between January 2005 and July 2017 were identified and matched by sex and age with up to four chronically ill (e.g. COPD, cardiovascular disease) patients. In both groups, relatives living in the same household were identified and included in this study. Primary outcome was the number of new episodes of care (International Classification of Primary Care-2) for up to five years. Hazard ratios (HRs) for the total number of new episodes were calculated. Results Relatives of ICU survivors (n = 267, mean age 38.1 years, 41.0% male) had significantly more new care episodes compared to the reference group (n = 705, mean age 36.3 years, 41.1% male) 1–2 years (median 0.11 vs. 0.08, HR 1.26; 95% confidence interval (CI) 1.03–1.54) and 2–5 years (median 0.18 vs. 0.13, HR 1.28; 95%CI 1.06–1.56) after ICU discharge. No differences were found in the period before ICU admission. Conclusion Relatives of ICU survivors present more morbidity in primary care than relatives of chronically ill patients up to five years after ICU discharge.
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Affiliation(s)
- Rick Naaktgeboren
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marco Peters
- Department of Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Peters
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris A van de Laar
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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18
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Apostol-Nicodemus L, Tabios IKB, Limpoco AGO, Domingo GDP, Tantengco OAG. Psychosocial Distress among Family Members of COVID-19 Patients Admitted to Hospital and Isolation Facilities in the Philippines: A Prospective Cohort Study. J Clin Med 2022; 11:jcm11175236. [PMID: 36079167 PMCID: PMC9457412 DOI: 10.3390/jcm11175236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
This study determined the psychosocial impact of COVID-19 on families of adult COVID-19 patients in isolation facilities in Metro Manila, Philippines. This prospective cohort study was conducted in COVID-19 healthcare facilities. Data collection was undertaken 2 weeks and 8 weeks after discharge. Logistic regression was performed to determine the socioeconomic and clinical factors influencing anxiety, depression, and family function. Based on HADS-P, 43.2% of the participants had anxiety symptoms, and 16.2% had depression symptoms 2 weeks after the discharge of their relative with COVID-19 infection. The prevalence of anxiety and depression significantly decreased to 24.3% and 5.4%, respectively, 8 weeks after discharge. The percentage of participants with a perceived moderate family dysfunction was 9.5% in the 2nd week and 6.8% in the 8th week post discharge. Participants with perceived severe family dysfunction increased from none to 4.1%. The most inadequate family resources for the participants were economic, medical, and educational resources. Patient anxiety (p = 0.010) and perceived inadequate family resources (p = 0.032) were associated with anxiety symptoms among family members. Patient anxiety (p = 0.013) and low educational attainment (p = 0.002) were associated with anxiety symptoms among family members 8 weeks after discharge. On the other hand, patient depression (p = 0.013) was a factor related to depressive symptoms among family members 2 weeks after discharge. This study provided an in-depth understanding of the mental health status of family members caring for relatives with COVID-19 infection. This can be used to guide healthcare professionals caring for COVID-19 patients and their family members.
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Affiliation(s)
- Leilanie Apostol-Nicodemus
- Department of Family and Community Medicine, University of the Philippines—Philippine General Hospital, Taft Avenue, Manila 1000, Philippines
- Correspondence: (L.A.-N.); (I.K.B.T.)
| | - Ian Kim B. Tabios
- Institute of Biology, College of Science, University of the Philippines Diliman, Quezon City 1101, Philippines
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
- Correspondence: (L.A.-N.); (I.K.B.T.)
| | - Anna Guia O. Limpoco
- Department of Family and Community Medicine, University of the Philippines—Philippine General Hospital, Taft Avenue, Manila 1000, Philippines
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Michel J, Kilb TS, Mettler A, Müller M, Hautz WE, Hautz SC, Sauter TC. The Utility of an Online Forward Triage Tool During the SARS-CoV-2 Pandemic: Health Care Provider and Health Authority Perspectives. Front Public Health 2022; 10:845996. [PMID: 35874994 PMCID: PMC9305458 DOI: 10.3389/fpubh.2022.845996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The SARS CoV-2 pandemic poses major challenges not only to patients but also to health care professionals and policy-makers, with rapidly changing, sometimes complex, recommendations, and guidelines to the population. Online forward triage tools (OFTT) got a major boost from the pandemic as they helped with the implementation and monitoring of recommendations. Methods A multiphase mixed method sequential explanatory study design was employed. Quantitative data were collected first and informed the qualitative interview guides. Video interviews were held with key informants (health care providers and health authorities) between 2 September and 10 December 2020. Audio-recordings were transcribed verbatim, coded thematically and compared with patient perspectives (framework). Objectives To explore the perspectives of health care providers and authorities in Canton Bern on the utility of a COVID-19 OFTT, as well as elicit recommendations for telehealth in future. Results The following themes emerged; (i) accessibility (ii) health system burden reduction (iii) utility in preventing onward transmission (iv) utility in allaying fear and anxiety (v) medical decision-making utility (vi) utility as information source (vii) utility in planning and systems thinking. The health care providers and health authorities further provided insights on potential barriers and facilitators of telehealth in future. Conclusion Similar to patients, health care providers acknowledge the potential and utility of the COVID-19 OFTT particularly as an information source and in reducing the health system burden. Data privacy, doctor-patient relationship, resistance to change, regulatory, and mandate issues, and lack of systems thinking were revealed as barriers to COVID-19 OFTT utility.
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Keilholtz BM, Spencer CM, Stith SM. Common Life Stressors as Risk Markers for Intimate Partner Violence: A Meta-analysis. CONTEMPORARY FAMILY THERAPY 2022. [DOI: 10.1007/s10591-022-09633-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Haque MR, Khan MMA, Rahman MM, Rahman MS, Begum SA. Mental health status of informal waste workers during the COVID-19 pandemic in Bangladesh. PLoS One 2022; 17:e0262141. [PMID: 34995288 PMCID: PMC8741044 DOI: 10.1371/journal.pone.0262141] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
The deadliest coronavirus disease 2019 (COVID-19) is taking thousands of lives worldwide and presents an extraordinary challenge to mental resilience. This study assesses mental health status during the COVID-19 pandemic and its associated factors among informal waste workers in Bangladesh. A cross-sectional survey was conducted in June 2020 among 176 informal waste workers selected from nine municipalities and one city corporation in Bangladesh. General Health Questionnaire (GHQ-12) was used to assess respondents’ mental health. The study found that 80.6% of the individuals were suffering from psychological distress; 67.6% reported anxiety and depression, 92.6% reported social dysfunction, and 19.9% reported loss of confidence. The likelihood of psychological distress (Risk ratio [RR]: 1.23, 95% confidence interval [CI]: 1.02–1.48) was significantly higher for female than male. Multiple COVID-19 symptoms of the family members (RR: 1.20, 95% CI: 1.03–1.41), unawareness about COVID-19 infected neighbor (RR: 1.21, 95% CI: 1.04–1.41), income reduction (RR: 1.60, 95% CI: 1.06–2.41) and daily household meal reduction (RR: 1.34; 95% CI: 1.03–1.73) were also found to be associated with psychological distress. These identified factors should be considered in policy-making and support programs for the informal waste workers to manage the pandemic situation as well as combating COVID-19 related psychological challenges.
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Affiliation(s)
| | - Md. Mostaured Ali Khan
- MEL and Research, Practical Action, Dhanmondi, Dhaka, Bangladesh
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
- * E-mail:
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Al-Janabi H, Wittenberg E, Donaldson C, Brouwer W. The relative value of carer and patient quality of life: A person trade-off (PTO) study. Soc Sci Med 2021; 292:114556. [PMID: 34823129 DOI: 10.1016/j.socscimed.2021.114556] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/30/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
Carer quality of life is increasingly considered alongside patient quality of life in economic evaluation. Important questions remain about how to value carer and patient quality of life effects alongside one another. In this study, we estimated the relative social value of two conceptualisations of carer quality of life (health-related and care-related) compared to patient quality of life. Relative valuations were estimated using a person trade-off (PTO) study with 990 representative members of the UK public. Participants chose between hypothetical services that improved the quality of life of carers and patients, iterating to a point of indifference. Overall 84% of participants completing the task were willing to trade patient and carer quality of life effects. Relative to a reference point of 1 for patient health-related quality of life, we estimated a social value of 0.74 for carer health-related quality of life effects and 0.69 for carer care-related quality of life effects. In conclusion, public preferences appear to support the inclusion of carer quality of life effects within economic evaluation. The results provide a means to value different carer quality of life outcomes in economic evaluation, where such values are needed and deemed appropriate.
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Affiliation(s)
- Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, UK.
| | - Eve Wittenberg
- Harvard TH Chan School of Public Health, Harvard University, United States
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, UK
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
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Patient activation and treatment decision-making in the context of cancer: examining the contribution of informal caregivers' involvement. J Cancer Surviv 2021; 16:929-939. [PMID: 34510365 DOI: 10.1007/s11764-021-01085-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE The present work investigated the relationship between patient activation, treatment decision-making, and adherence to the prescribed treatment regimen. Given the role of informal caregivers in patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship. METHODS Survey data collected from 504 cancer survivors were utilized. Structural equation modeling (SEM) controlling for covariates was used to examine the relationship between patient activation measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM. RESULTS Patient activation was significantly associated with treatment planning being reflective of survivors' goals and values (p < 0.001); adherence to treatment (p = 0.011); and satisfaction (p < 0.001). Caregiver's involvement significantly moderated the association between activation and adherence to treatment. CONCLUSIONS Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver's involvement, patient activation was not associated with treatment adherence. Research is needed to test and deliver self-management interventions inclusive of informal caregivers. IMPLICATIONS FOR CANCER SURVIVORS Findings supported the need not only to monitor and sustain patient activation across the cancer continuum, but also to assume a dyadic perspective when designing self-management interventions in cancer survivorship.
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Lee D, Kim Y, Devine B. Spillover Effects of Mental Health Disorders on Family Members' Health-Related Quality of Life: Evidence from a US Sample. Med Decis Making 2021; 42:80-93. [PMID: 34378438 DOI: 10.1177/0272989x211027146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to characterize the spillover effects of selected mental health disorders (episodic mood disorder (EMD), anxiety, substance use disorder (SUD), schizophrenia, attention-deficit/hyperactivity disorder (ADHD), and dementia) on family members' health-related quality of life and to compare the magnitude of spillover effects across these types. METHODS Using the 2000-2015 Medical Expenditure Panel Survey, households having individuals with mental health disorders were identified. The SF-12 and EQ-5D surveys were used to acquire utility and health status scores for household members. The outcomes in households including an individual with a mental health disorder were compared to those of the control group (absence of individuals with mental health disorders in the household). We also compared a total of 15 pairs of diseases based on the SF-6D scores. A beta generalized estimating equation model was employed. RESULTS Average scores of utility and health status among individuals living with a member with a mental health disorder in the household were statistically lower than those of the control group and; for the SF-6D, met the minimally important difference for SUD, schizophrenia, and dementia. Differences in the SF-6D scores were statistically significant for 5 pairs of the mental health disorders: EMD-anxiety, EMD-ADHD, dementia-anxiety, dementia-ADHD, and schizophrenia-ADHD. CONCLUSIONS This study provides evidence of family spillover effects in mental illness using both utility and health status measures from a US representative sample. Integrating this evidence into clinical and policy decision making as well as economic evaluations would allow for a more comprehensive valuation of the societal benefits of mental and behavioral health interventions.
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Affiliation(s)
- Donghoon Lee
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Yeonil Kim
- Merck Research Laboratories, Merck & Co Inc, Rahway, NJ, USA
| | - Beth Devine
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
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Al-Janabi H, Efstathiou N, McLoughlin C, Calvert M, Oyebode J. The scope of carer effects and their inclusion in decision-making: a UK-based Delphi study. BMC Health Serv Res 2021; 21:752. [PMID: 34325700 PMCID: PMC8320027 DOI: 10.1186/s12913-021-06742-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background and objective Health and social care may affect unpaid (family) carers’ health and wellbeing in addition to patients’ lives. It is recommended that such impacts (carer effects) are considered in decision-making. However, the scope of carer effects and range of decisions where carer effects should be considered is uncertain. This study aimed to identify: (i) how different categories of healthcare and social care were perceived to impact on unpaid carers; and (ii) whether there was consensus about when carer effects should be formally considered in decision-making contexts. Methods A two round, online Delphi study was conducted with 65 UK-based participants (unpaid carers, care professionals, and researchers) with expertise in dementia, mental health, and stroke. Participants considered two broad forms of ‘interventions’ (patient treatment and replacement care) and two broad forms of ‘organisational change’ (staffing and changes in timing/location of care). Participants assessed the likely impacts of these on unpaid carers and whether impacts should be considered in decision-making. Results Participants predicted interventions and organisational changes would impact on multiple domains of unpaid carers’ lives, with ‘emotional health’ the most likely outcome to be affected. Patient treatment and replacement care services (‘interventions’) were associated with positive impacts across all domains. Conversely, timing/location changes and staffing changes (‘organisational changes’) were perceived to have mixed and negative impacts. There was widespread support (80–81 %) for considering carer effects in research studies, funding decisions, and patient decision-making. Conclusions This study highlights a perception that carer effects are widespread and important to consider in economic evaluation and decision-making. It highlights the particular need to measure and value effects on carers’ emotional health and the need to use a societal perspective to avoid cost shifting to unpaid carers when introducing interventions and making organisational changes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06742-4.
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Affiliation(s)
- Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, Birmingham, UK.
| | - Nikolaos Efstathiou
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Centre, West Midlands, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, B15 2TT, Edgbaston, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University Hospitals, University of Birmingham, B15 2TT, Edgbaston, Birmingham, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Bradford, Richmond Rd, BD7 1DP, Bradford, UK
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Henry E, Cullinan J. Mental health spillovers from serious family illness: Doubly robust estimation using EQ-5D-5L population normative data. Soc Sci Med 2021; 279:113996. [PMID: 33993007 DOI: 10.1016/j.socscimed.2021.113996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
People are interconnected and ill-health is rarely experienced in isolation. However, while there has been extensive research on health spillovers related to informal caregiving, there is comparatively little evidence on how ill-health may impact upon non-caregiving family members. This paper analyses EQ-5D-5L normative data from a nationally representative sample of adult residents of Ireland to estimate the independent relationship between serious family illness and five distinct dimensions of health. The empirical strategy combines inverse probability weighting and multivariate ordered probit regression in a doubly robust estimation. We find that experience of serious family illness is associated with large mental health decrements that are independent of caring responsibilities, while similar results are not evident for the four other health dimensions. Furthermore, stratified sub-sample analyses indicate considerable heterogeneity by sex and by income. In particular, we find evidence consistent with larger mental health spillovers for females than for males, as well as for low- and medium-income households relative to high-income households. The latter suggests that such spillovers may be substantially worse for those with fewer resources. Overall, the findings have a range of potential implications, including for the provision of mental health supports and services, for equity of health outcomes, as well as for health economic evaluation. For example, we calculate that our estimates of health spillovers are consistent with a 1.3% reduction in health utility for non-caregiving family members.
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Affiliation(s)
- Edward Henry
- Discipline of Economics, National University of Ireland Galway, Ireland.
| | - John Cullinan
- Discipline of Economics, National University of Ireland Galway, Ireland.
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Psychological, sociocultural and economic coping strategies of mothers or female caregivers of children with a disability in Belu district, Indonesia. PLoS One 2021; 16:e0251274. [PMID: 33956859 PMCID: PMC8101963 DOI: 10.1371/journal.pone.0251274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
Caring for children with a disability can cause a range of psychological and socioeconomic challenges for parents and caregivers, such as anxiety, depression, inability to find affordable and appropriate childcare, loss of income and expenses related to disability specific treatment. As part of a study exploring the impacts of childhood disability on mothers or female caregivers and families, and the copy strategies they used, this paper describes strategies employed by mothers or female caregivers to cope with challenges associated with childhood disability within their family in Belu district, Indonesia. A qualitative approach using one-on-one in-depth interviews was used to collect data from participants (n = 22) who were recruited using a combination of purposive and snowball sampling techniques. Interviews were recorded, transcribed verbatim and imported to NVivo 12 for analysis. A qualitative framework analysis was used to guide data analysis. The conceptual framework of coping strategies guided the conceptualisation and discussion of the findings. The findings showed that active psychological coping strategies, including cognitive or acceptance strategies, knowledge of both health condition and socio-academic related development of children with a disability, and family relationship and support, were used by the participants to cope with psychological challenges facing them. Self-reliance and religious/spiritual coping strategies were also utilised. Sociocultural strategies, such as social withdrawal or disengagement, professional support and culture-based support, were used by the participants to cope with social impacts, stigma, and discrimination associated with childhood disability. Participants also reported using financial strategies such as selling of family assets to cope with the economic challenges. The findings indicate the need for programs and interventions that address the needs of mothers and female caregivers and their families, to assist with effectively managing the significant challenges they face when caring for a child with a disability. Further studies are needed, with a larger number of participants and the inclusion of fathers or male caregivers, in order to better understand the broader coping experience of childhood disability impacts within families.
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Jørgensen SE, Michelsen SI, Andersen A, Tolstrup JS, Thygesen LC. Identifying and Characterizing Children of Parents with a Serious Illness Using Survey and Register Data. Clin Epidemiol 2021; 13:253-263. [PMID: 33833582 PMCID: PMC8021136 DOI: 10.2147/clep.s294919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the prevalence and characterize children and adolescents aged 0–21 years with a physically or mentally ill parent based on registers. Further, to explore the use of register and survey data to identify parental serious illness. Methods The study is based on: 1) a 20% register sample of children and adolescents aged 0–21 in 2014; and 2) survey data from the Danish Youth Profile 2014 including 63,437 youth education students linked to registers. In registers, parental physical illness comprised hospital diagnoses included in the Charlson Comorbidity Index, and parental mental illness encompassed all mental diagnosis in the registers. Information about socioeconomic and demographic characteristics and use of health care services was retrieved from national registers. In the survey, students were asked if they had experienced serious illness of a parent. Results In the register sample of 0–21-year-olds, 25.3% had a parent with a physical or mental diagnosis, the prevalence increasing with age of the child. Compared to children without parental illness, children with an ill parent more frequently had unemployed parents, lower parental educational level, and a chronic medical condition. Analyses of the discrepancies between register and survey data revealed that 9% of the adolescents were identified as having an ill parent in both data sources and 64.1% had no identified ill parents. Moreover, a higher frequency of parental primary health care service use was seen for adolescents with an ill parent, across identification method, indicating that both methods identify adolescents with an ill parent. Conclusion The social inequality and elevated frequency of health problems among children and adolescents with an ill parent, underline the vulnerability of this population. Parental illness can be identified from both parental hospital diagnoses as well as self-reported by adolescents, however the two methods detect different populations. Both methods have several limitations and would benefit from further refinement and validation.
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Affiliation(s)
| | - Susan I Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, 8200, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, 1455, Denmark
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Joshi S, Joshi U, Bahl A, Arya D, Anand AK, Arora RS. Exploring the Financial Toxicities of Patients with Locally Advanced Head and Neck Malignancies, Being Treated in a Private Sector Hospital in North India: A Thematic Analysis. Indian J Palliat Care 2021; 27:118-125. [PMID: 34035629 PMCID: PMC8121222 DOI: 10.4103/ijpc.ijpc_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The high cost of cancer diagnosis and treatment is a global concern. Evidence derived, mostly from high-income countries, shows how it gradually impacts the personal and household financial condition causing the increased psychosocial burden of the patient and their families (termed “financial toxicity”). Aim: To qualitatively explore the financial toxicities in patients with advanced head and neck malignancies in India, and to consider how it impacts the patient and his family. Methods: Interviewing a purposive sample of 8 patients using semi-structured interviews face to face. Interviews were transcribed verbatim, and a thematic content analysis was carried out. Results: Four major themes were identified: burden and amplifying factors, impact, rescue and relieving factors, and learning and innovation. The burden of cost relates to diagnosis, treatment and non-medical costs which gets amplified while navigating the healthcare labyrinth. Emerging themes describe financial journey of cancer patients, the issues faced by them and the ways they tackle these issues during their treatment. Healthcare system factors like limited availability of adequate/comprehensive/meaningful insurance and reimbursements potentiate the toxicity. The financial toxicity leads to a significant adverse financial, psychological and social impact on the patient and the family. While moving through the process of care, there were a few learnings and innovations which patients proposed. Conclusion: This study provides qualitative evidence of the considerable and pervasive nature of financial toxicity in head and neck cancer patients in India. The findings have implications for all cancer patients and highlight the unmet need of psychosocial support for these patients.
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Affiliation(s)
- Saurabh Joshi
- Consultant Palliative and Pain Medicine, Hospice India, New Delhi, India
| | - Upkar Joshi
- Senior Finance and Economics Expert, Founder Ascent Wealth Desk, Visiting Faculty- Delhi University, New Delhi, India
| | - Ankur Bahl
- Senior Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - Devavrat Arya
- Principal Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - A K Anand
- Chief Radiation Oncology and Senior Director, Max Super Specialty Hospital, New Delhi, India
| | - Ramandeep Singh Arora
- Senior Consultant, Paediatric Oncology, Max Super Speciality Hospital, New Delhi, India
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Khorsandi F, Parizad N, Feizi A, Hemmati MaslakPak M. How do parents deal with their children's chronic kidney disease? A qualitative study for identifying factors related to parent's adaptation. BMC Nephrol 2020; 21:509. [PMID: 33238900 PMCID: PMC7690036 DOI: 10.1186/s12882-020-02170-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/15/2020] [Indexed: 01/05/2023] Open
Abstract
Background Parents’ adaptation affects the health outcomes of children with chronic kidney diseases (CKD). Identifying factors that affect parents’ adaptation is necessary to understand their adaptation status. This study aims to explore factors related to the adaptation of parents who have children with CKD. Methods This was a qualitative study with a content analysis approach. Seventeen parents of children with CKD were selected by using purposive sampling. The leading researcher performed semi-structured, in-depth, face-to-face interviews to collect data. Conventional content analysis was used to analyze data. Results Two main categories extracted from the data were “adaptation facilitators” and “adaptation barriers.” Adaptation facilitators were supported by three sub-categories: “social support”, “family capability” and “spiritual beliefs”. Four sub-categories of “adaptation barriers” were revealed as: “family-related barriers,” “mental stress by others,” “the chronic nature of the disease,” and “unfavorable treatment conditions.” Conclusions Identifying the factors influencing parental adaptation helps the medical staff to make the necessary interventions to support the parents. According to this study, increasing parent access to the required information, supporting them financially and emotionally, and helping them identify support resources can facilitate their adaptation to their child’s chronic illness. Also, identifying and eliminating adaptation barriers can help parents deal better with their child’s chronic disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02170-4.
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Affiliation(s)
- Fatemeh Khorsandi
- Department of Medical - Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, IR, Iran
| | - Naser Parizad
- Patient Safety Research Center, Urmia University of Medical Science, Urmia, IR, Iran
| | - Aram Feizi
- Department of Management, Psychology, Community, and Fundamental nursing, Urmia, IR, Iran
| | - Masumeh Hemmati MaslakPak
- Center for Mother and Child Obesity Research Center, Urmia University of Medical Sciences, Urmia, IR, Iran. .,Nursing and Midwifery Faculty, Campus Nazlu, 11 KM Road Seru, Urmia, West Azerbaijan, 575611-5111, Iran.
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Employment changes among Chinese family caregivers of long-term cancer survivors. BMC Public Health 2020; 20:1787. [PMID: 33238976 PMCID: PMC7690119 DOI: 10.1186/s12889-020-09922-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/18/2020] [Indexed: 12/28/2022] Open
Abstract
Background Family caregivers (FCGs) play a key role in the plan of care provision for long-term cancer survivors, yet few studies have been conducted on the impact of long-term caregiving on FCGs and their employment patterns. This study aims to further our understanding of the effect that caregiving role has on FCGs by identifying what cancer-related characteristics influence reduction of employment hours among FCGs in the post-treatment phase in China. Methods A total of 1155 cancer survivors participated in this study. Patients reported changes in the employment patterns of their FCGs. Descriptive analysis looked at demographic and cancer-related characteristics of cancer survivors and types of FCGs’ employment changes in both primary- and post-treatment phases. Chi-square test was used to statistically test the association between survivors’ characteristics and changes in FCGs’ hours of labor force work in post-treatment phase. Separate multivariable logistic regression models were used to examine the relationship between cancer-related characteristics of participants and employment reduction patterns among FCGs in post-treatment phase while controlling for demographic factors. Results In the primary-treatment phase, 45.6% of all FCGs reduced their working hours and 17.4% stopped working altogether. In the post-treatment phase, 25.2% of FCGs worked fewer hours and 6.6% left the workforce completely. The results show that a higher probability of change in employment hours among FCGs is associated with the following patient characteristics: having comorbidities, receiving chemotherapy treatment, limited ability to perform physical tasks, limited ability to perform mental tasks, and diagnosis of stage II of cancer. Conclusions Care for cancer patients in both primary- and post- treatment phases may have substantial impacts on hours of formal employment of Chinese FCGs. Interventions helping FCGs balance caregiving duties with labor force work are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09922-9.
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Asa GA, Fauk NK, Ward PR, Mwanri L. The psychosocial and economic impacts on female caregivers and families caring for children with a disability in Belu District, Indonesia. PLoS One 2020; 15:e0240921. [PMID: 33147246 PMCID: PMC7641436 DOI: 10.1371/journal.pone.0240921] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/05/2020] [Indexed: 11/22/2022] Open
Abstract
The current study aimed to understand psychosocial and economic impacts of female caregivers and families caring for children with a disability in Belu district, Indonesia. A qualitative inquiry employing one-on-one in-depth interviews was used to collect data from participants (n = 22). Data analysis was guided by a framework analysis for qualitative research. Social implications framework and the economic consequence of disease and injury framework were used to guide the conceptualisation, analysis and discussion of the findings. Findings indicated that female caregivers of children with a disability experienced significant psychosocial challenges. These included feeling frustrated, sad, angry, worried, inferior and insecure due to rejection of their children by other kids with no disability. Poor physical conditions of and negative labelling given to their children and the fear of what the future held for their children with a disability added yet another layer of psychosocial challenges experienced by these women. Separation or divorce and reduced social interaction and engagement in the community were expressed social impact loaded to these women resulting from poor acceptability of the children by their fathers, increased time spent caring and discriminatory and stigmatising attitudes against their children with a disability. The participants also experienced economic impacts, such as increased health and transport expenses, loss of jobs and productivity, and lack of savings. The findings indicate the need for programs and interventions addressing the needs of mothers or female caregivers and families with disabled children. Further studies with large number of participants covering mothers, fathers and caregivers to understand broader experiences and the need of caring for children with a disability are recommended.
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Affiliation(s)
- Gregorius Abanit Asa
- Sanggar Belajar Alternatif (SALT), Atambua, Nusa Tenggara Timur, Indonesia
- * E-mail:
| | - Nelsensius Klau Fauk
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, Kupang, Nusa Tenggara Timur, Indonesia
| | - Paul Russell Ward
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Dibley L, Williams E, Young P. When Family Don't Acknowledge: A Hermeneutic Study of the Experience of Kinship Stigma in Community-Dwelling People With Inflammatory Bowel Disease. QUALITATIVE HEALTH RESEARCH 2020; 30:1196-1211. [PMID: 30845887 DOI: 10.1177/1049732319831795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Recent evidence suggests that kinship stigma-the experience of being or feeling stigmatized by family members-arises in the stories of people with inflammatory bowel disease (IBD). Adopting Goffman's definition of stigma as "an attribute which is deeply discrediting," we used hermeneutic (interpretive) phenomenology to further explore the meaning of kinship stigma for people with IBD and reveal its significance. In total, 18 unstructured interviews took place in participants' own homes in the United Kingdom, between July 2015 and April 2016. Transcripts were analyzed using a hermeneutic method to reveal three relational themes and one constitutive pattern. Referring to relevant literature, the presence and impact of kinship stigma on people with IBD is revealed. Kinship stigma-experienced as and meaning a lack of acknowledgment-may have wide-ranging implications for health and social care professionals caring for persons with IBD or other chronic illness and their families.
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Affiliation(s)
- Lesley Dibley
- University of Greenwich, London, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
| | - Ellen Williams
- The University of Mississippi Medical Centre, Jackson, Mississippi, USA
- University of North Alabama, Florence, Alabama, USA
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Bortes C, Strandh M, Nilsson K. Sibling Ill Health and Children's Educational Outcomes. THE JOURNAL OF SCHOOL HEALTH 2020; 90:407-414. [PMID: 32105351 PMCID: PMC7187141 DOI: 10.1111/josh.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The presence of health problems in a child is known to be negatively associated with later academic achievement, but less is known about the educational outcomes for siblings of children in poor health. The study investigated how having a sibling with health problems affects a healthy sibling's academic achievement. METHODS We utilized medical and social microdata from Swedish administrative population registers. Our sample consisted of N = 115,106 individuals (51.3% boys) born in 1990 in Sweden. We compared children with ill siblings to children whose siblings did not have poor health. Siblings' hospital admissions and the academic achievements of the healthy sibling during their final year of compulsory education (at the age of 15-16) were analyzed using linear and logistic regression in relation to individual health- and family-related confounders. RESULTS Sibling hospitalization was significantly associated with lower overall grade points (β = -10.73, p < .001) and an increased odds ratio (OR) of ineligibility for upper secondary education (OR = 1.42, 95% confidence interval = 1.31-1.52, p < .001). CONCLUSIONS School and health personnel should also consider the needs of healthy siblings during their work with children in poor health, because they too can be disadvantaged.
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Affiliation(s)
- Cristian Bortes
- Umeå University, Department of Social Work, Faculty of Social SciencesUmeåSE‐901 87Sweden
| | - Mattias Strandh
- Umeå University, Department of Social Work, Faculty of Social Sciences, Umeå SE‐901 87, Sweden; Karlstad University, Centre for Research on Child and Adolescent Mental HealthKarlstadSE‐651 88Sweden
| | - Karina Nilsson
- Umeå University, Department of Sociology, Faculty of Social SciencesUmeåSE‐901 87Sweden
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Shelton CA, Grubs RE, Umapathy C, Yadav D, Whitcomb DC. Impact of hereditary pancreatitis on patients and their families. J Genet Couns 2020; 29:971-982. [PMID: 32026589 DOI: 10.1002/jgc4.1221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/08/2020] [Accepted: 01/12/2020] [Indexed: 12/15/2022]
Abstract
Hereditary pancreatitis (HP), a highly penetrant (~80%) autosomal dominant disease associated with PRSS1 variants, causes acute pancreatitis in childhood and chronic pancreatitis by early adulthood. Other clinical features include pain, diabetes, and risk of pancreatic cancer. HP kindreds were prospectively recruited from 1995 to 2015. At enrollment, study participants completed medical and family history questionnaires, and provided samples for genotyping. Participants were recontacted between 2015 and 2017 and asked to complete a survey on concerns and experiences related to HP, PRSS1 testing, and genetic counseling. Data were analyzed with descriptive and thematic methods. Thirty-nine affected participants with HP and 21 unaffected family members completed the survey. Among unaffected family members, 'worry' and 'helplessness' were frequently described as the most difficult problem in their family because of HP, particularly with regard to pain. Three participants described the impact of drug addiction on their family. 'School or work limitations' was the leading financial concern, with 65.5% (36/55) rating it as 'moderately' or 'extremely important.' Unexpectedly, only 62% (21/34) of affected PRSS1 carriers believed the chance for a parent to pass HP to his or her children was 50%, whereas 18% (6/34) believed the chance was 100%. The impact of HP on individuals and families varied, which may reflect the highly unpredictable nature of HP severity and outcomes. Based on current and previously reported findings, an overview of important issues for genetic counselors to consider for counseling HP families is included.
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Affiliation(s)
- Celeste A Shelton
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robin E Grubs
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chandraprakash Umapathy
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David C Whitcomb
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Basak RB, Momaya R, Guo J, Rathi P. Role of Child Life Specialists in Pediatric Palliative Care. J Pain Symptom Manage 2019; 58:735-737. [PMID: 31195077 DOI: 10.1016/j.jpainsymman.2019.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Ratna B Basak
- Brookdale University Hospital Medical Center, Brooklyn, New York, USA; Flushing Hospital Medical Center, Flushing, New York, USA.
| | - Rashmi Momaya
- Flushing Hospital Medical Center, Flushing, New York, USA
| | - Junjing Guo
- Flushing Hospital Medical Center, Flushing, New York, USA
| | - Pooja Rathi
- Kaiser South Sacramento Hospital, Sacramento, California, USA
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Managing family burden through combined family psychoeducation and care decision without pasung therapies. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Buse DC, Fanning KM, Reed ML, Murray S, Dumas PK, Adams AM, Lipton RB. Life With Migraine: Effects on Relationships, Career, and Finances From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2019; 59:1286-1299. [PMID: 31407321 PMCID: PMC6771487 DOI: 10.1111/head.13613] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 12/23/2022]
Abstract
Objective To assess the effects of migraine on important life domains and compare differences between respondents with episodic and chronic migraine and between sexes. Background Migraine is associated with a substantial personal and societal burden and can also affect the interpersonal dynamics, psychological health and well‐being, and financial stability of the entire family of the person with migraine. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a prospective, longitudinal, Web‐based survey study undertaken between September 2012 and November 2013 in a systematic U.S. sample of people meeting modified International Classification of Headache Disorders, 3rd edition migraine criteria: 19,891 respondents were invited to complete the Family Burden Module, which assessed the perceived impact of migraine on family relationships and life, career and finances, and overall health. Respondents were stratified by episodic migraine (<15 headache days/month) and chronic migraine (≥15 headache days/month) and sex for comparisons. Results A total of 13,064 respondents (episodic migraine: 11,944 [91.4%]; chronic migraine: 1120 [8.6%]) provided valid data. Approximately 16.8% of respondents not currently in a romantic relationship (n = 536 of 3189) and 17.8% of those in a relationship but not living together (n = 236 of 1323) indicated that headaches had contributed to relationship problems. Of those in a relationship and living together (n = 8154), 3.2% reported that they chose not to have children, delayed having children or had fewer children because of migraine (n = 260; episodic migraine: n = 193 of 7446 [2.6%]; chronic migraine: n = 67 of 708 [9.5%]; P < .001). Of individuals responding to career/finance items (n = 13,061/13,036), 32.7% indicated that headaches negatively affected ≥1 career area (n = 4271; episodic migraine: n = 3617 of 11,942 [30.3%]; chronic migraine: n = 654 of 1119 [58.4%]), and 32.1% endorsed worry about long‐term financial security due to migraine (n = 4180; episodic migraine: n = 3539 of 11,920 [29.7%]; chronic migraine: n = 641 of 1116 [57.4%]). Conclusions Migraine can negatively affect many important aspects of life including marital, parenting, romantic and family relationships, career/financial achievement and stability, and overall health. Reported burden was consistently greater among those with chronic migraine than among people with episodic migraine; however, few differences were seen between the sexes.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Sharron Murray
- American Migraine Foundation Partner, Wenatchee, WA, USA
| | - Paula K Dumas
- Executive Team, Migraine Again LLC, Alpharetta, GA, USA
| | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Bronx, NY, USA
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Al-Janabi H, McLoughlin C, Oyebode J, Efstathiou N, Calvert M. Six mechanisms behind carer wellbeing effects: A qualitative study of healthcare delivery. Soc Sci Med 2019; 235:112382. [PMID: 31326132 DOI: 10.1016/j.socscimed.2019.112382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/26/2019] [Accepted: 06/21/2019] [Indexed: 11/28/2022]
Abstract
Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic 'IMPACT'. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients.
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Affiliation(s)
- Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, Richmond Rd, Bradford, BD7 1DP, UK
| | - Nikolaos Efstathiou
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, UK; NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK
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Incorporating Household Spillovers in Cost Utility Analysis: A Case Study Using Behavior Change in COPD. Int J Technol Assess Health Care 2019; 35:212-220. [PMID: 31064563 DOI: 10.1017/s026646231900028x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES It is important to capture all health effects of interventions in cost-utility analyses conducted under a societal or healthcare perspective. However, this is rarely done. Household spillovers (health effects on patients' other household members) may be particularly likely in the context of technologies and interventions to change behaviors that are interdependent in the household. Our objective was to prospectively collect outcome data from household members and illustrate how these can be included in a cost-utility analysis of a behavior change intervention in chronic obstructive pulmonary disease (COPD). METHODS Data were collected from patients' household members (n = 153) alongside a randomized controlled trial of a COPD self-management intervention. The impact of the intervention on household members' EQ-5D-5L scores (primary outcome), was evaluated. Analyses were then carried out to estimate household members' quality-adjusted life-years (QALYs) and assess the impact of including these QALYs on cost-effectiveness. RESULTS The intervention had a negligible spillover on household members' EQ-5D-5L scores (-0.007; p = .75). There were also no statistically significant spillovers at the 5 percent level in household member secondary outcomes. In the base-case model, the inclusion of household member QALYs in the incremental cost-effectiveness ratio (ICER) denominator marginally increased the ICER from GBP 10,271 (EUR 13,146) to GBP 10,991 (EUR 14,068) per QALY gained. CONCLUSIONS This study demonstrates it is feasible to prospectively collect and include household members' outcome data in cost utility analysis, although the study highlighted several methodological issues. In this case, the intervention did not impact significantly on household members' health or health behaviors, but inclusion of household spillovers may make a difference in other contexts.
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Dixon P, Round J. Caring for Carers: Positive and Normative Challenges for Future Research on Carer Spillover Effects in Economic Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:549-554. [PMID: 31104733 PMCID: PMC6524130 DOI: 10.1016/j.jval.2018.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Many individuals rely on family and friends to provide care outside of the formal healthcare sector. The need for caring is driven by many factors, including government policies toward health and social care, and increased prevalence of chronic and comorbid conditions. Informal care may give rise to "spillover" effects from the health of a cared-for individual to the health of carers. Spillover effects are rarely reflected in economic evaluations, in spite of growing research interest in this area, and recommendations from bodies such as the National Institute for Health and Care Excellence (NICE) and the Second Panel on Cost-Effectiveness that effects of this type be included in cost-effectiveness analysis. OBJECTIVE We explore the positive and normative issues to which the inclusion of carer spillover effects in economic evaluation may give rise and how future research might begin to address these challenges. RESULTS Positive challenges include the identification of causal rather than coincidental impacts on carers, selection into caring, and the measurement and treatment of spillover effects. The normative issues are related to these challenges, and particularly include impacts on equity, and spillovers that improve rather than reduce the health of carers. CONCLUSIONS We argue that challenges including spillover effects in economic evaluation are considerable. Avenues for future research and possible solutions to these challenges include a re-orientation of analytic perspectives so that the impacts of caring on carers are accounted for where appropriate, and the design of studies to collect robust evidence to inform debate and guidance development in this area.
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Affiliation(s)
- Padraig Dixon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, England, UK.
| | - Jeff Round
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
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Wittenberg E, James LP, Prosser LA. Spillover Effects on Caregivers' and Family Members' Utility: A Systematic Review of the Literature. PHARMACOECONOMICS 2019; 37:475-499. [PMID: 30887469 DOI: 10.1007/s40273-019-00768-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND A growing body of research has identified health-related quality-of-life effects for caregivers and family members of ill patients (i.e. 'spillover effects'), yet these are rarely considered in cost-effectiveness analyses (CEAs). OBJECTIVE The objective of this study was to catalog spillover-related health utilities to facilitate their consideration in CEAs. METHODS We systematically reviewed the medical and economic literatures (MEDLINE, EMBASE, and EconLit, from inception through 3 April 2018) to identify articles that reported preference-based measures of spillover effects. We used keywords for utility measures combined with caregivers, family members, and burden. RESULTS Of 3695 articles identified, 80 remained after screening: 8 (10%) reported spillover utility per se, as utility or disutility (i.e. utility loss); 25 (30%) reported a comparison group, either population values (n = 9) or matched, non-caregiver/family member or unaffected individuals' utilities (n = 16; 3 reported both spillover and a comparison group); and 50 (63%) reported caregiver/family member utilities only. Alzheimer's disease/dementia was the most commonly studied disease/condition, and the EQ-5D was the most commonly used measurement instrument. CONCLUSIONS This comprehensive catalog of utilities showcases the spectrum of diseases and conditions for which caregiver and family members' spillover effects have been measured, and the variation in measurement methods used. In general, utilities indicated a loss in quality of life associated with being a caregiver or family member of an ill relative. Most studies reported caregiver/family member utility without any comparator, limiting the ability to infer spillover effects. Nevertheless, these values provide a starting point for considering spillover effects in the context of CEA, opening the door for more comprehensive analyses.
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Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Lyndon P James
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Tubeuf S, Saloniki EC, Cottrell D. Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England. PHARMACOECONOMICS 2019; 37:513-530. [PMID: 30294758 DOI: 10.1007/s40273-018-0722-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This article presents alternative parental health spillover quantification methods in the context of a randomised controlled trial comparing family therapy with treatment as usual as an intervention for self-harming adolescents, and discusses the practical limitations of those methods. METHODS The trial followed a sample of 754 participants aged 11-17 years. Health utilities are measured using answers to the EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L) for the adolescent and the Health Utility Index (HUI2) for one parent at baseline, 6 and 12 months. We use regression analyses to evaluate the association between the parent's and adolescent's health utilities as part of an explanatory regression model including health-related and demographic characteristics of both the adolescent and the parent. We then measure cost-effectiveness over a 12-month period as mean incremental cost-effectiveness ratios using various spillover quantification methods. We propose an original quantification based on the use of a household welfare function along with an equivalence scale to generate a health gain within the family to be added to the adolescent's quality-adjusted life-year gain. RESULTS We find that the parent's health utility increased over the duration of the trial and is significantly and positively associated with adolescent's health utility at 6 and 12 months but not at baseline. When considering the adolescent's health gain only, the incremental cost-effectiveness ratio is £40,453 per quality-adjusted life-year. When including the health spillover to one parent, the incremental cost-effectiveness ratio estimates range from £27,167 per quality-adjusted life-year to £40,838 per quality-adjusted life-year and can be a dominated option depending on the quantification method used. CONCLUSION According to the health spillover quantification method considered, the incremental cost-effectiveness ratios vary from within the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold range to not being cost-effective.
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Affiliation(s)
- Sandy Tubeuf
- Academic Unit of Health Economics, University of Leeds, Leeds, LS2 9NL, UK.
- Institute of Health and Society, Université Catholique de Louvain, Louvain-La-Neuve, Belgium.
| | - Eirini-Christina Saloniki
- Centre for Health Services Studies, University of Kent, Kent, UK
- Personal Social Services Research Unit, University of Kent, Kent, UK
| | - David Cottrell
- Psychological and Social Medicine, University of Leeds, Leeds, UK
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Lavelle TA, D'Cruz BN, Mohit B, Ungar WJ, Prosser LA, Tsiplova K, Vera-Llonch M, Lin PJ. Family Spillover Effects in Pediatric Cost-Utility Analyses. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:163-174. [PMID: 30350218 DOI: 10.1007/s40258-018-0436-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Childhood illness can impose significant costs and health strains on family members, but these are not routinely captured by pediatric economic evaluations. This review investigated how family "spillover effects" related to costs and health outcomes are considered in pediatric cost-utility analyses (CUAs). METHODS We reviewed pediatric CUAs published between 2000 and 2015 using the Tufts Medical Center Cost-effectiveness Analysis (CEA) Registry and the Pediatric Economic Database Evaluation (PEDE) Registry. We selected studies conducted from the societal perspective and included in both registries. We investigated how frequently family spillover was incorporated into analyses, and how the inclusion of spillover health effects and costs changed CUA results. RESULTS We found 142 pediatric CUAs meeting inclusion criteria. Of those, 105 (72%) considered either family spillover costs (n = 98 time costs, n = 33 out-of-pocket costs, n = 2 caregiver healthcare costs) or health outcomes (n = 15). Twenty-four studies included 43 pairs of incremental cost-effectiveness ratios (ICERs) with and without spillover. In 19 pairs of ICERs, adding spillover changed the ICER enough to cross a common cost-effectiveness threshold (i.e., $50,000/QALY, $100,000/QALY, $150,000/QALY; values are in 2016 US$). Incorporating spillover generally made interventions more cost-effective (n = 18; 42%), or did not change CUA results enough to cross a threshold (n = 24; 56%). Including family spillover reduced ICERs by 31% ($40,000/QALY) on average. CONCLUSION Most pediatric CUAs conducted from a societal perspective include family costs but fewer include family health effects. Inclusion of family spillover effects tends to make CUA results more favorable. Future pediatric CUAs should aim to more fully incorporate the family burden of illness.
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Affiliation(s)
- Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA.
| | - Brittany N D'Cruz
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA
| | - Babak Mohit
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA
| | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lisa A Prosser
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Kate Tsiplova
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | | | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #63, Boston, MA, 02111, USA
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Prosser LA, Wittenberg E. Advances in Methods and Novel Applications for Measuring Family Spillover Effects of Illness. PHARMACOECONOMICS 2019; 37:447-450. [PMID: 30915632 DOI: 10.1007/s40273-019-00794-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Lisa A Prosser
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, USA.
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, USA.
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, USA
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Hoefman RJ, van Exel J, Brouwer WBF. The Monetary Value of Informal Care: Obtaining Pure Time Valuations Using a Discrete Choice Experiment. PHARMACOECONOMICS 2019; 37:531-540. [PMID: 30298280 DOI: 10.1007/s40273-018-0724-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Interventions in health care often not only have an effect on patients, but also on their informal caregivers. Caregiving can have a profound impact on the health and wellbeing of carers. Ignoring these spillovers in economic evaluations risks labelling interventions mistakenly as cost-effective, at the expense of informal caregivers. OBJECTIVE This paper investigates willingness-to-accept (WTA) values for an hour of informal care, corrected for positive and negative impacts of informal care, to facilitate the inclusion of informal care hours on the cost side of economic evaluations without double-counting spillover effects. METHODS A discrete choice experiment (DCE) was conducted among a representative sample of the adult population in the Netherlands (n = 552) in September 2011. An experimental design minimizing the D-error was used to construct choice sets with two unlabelled alternatives with the attributes 'hours caregiving', 'monetary compensation for caregiving' and seven impacts of caregiving. To operationalize the random utility model, we used a panel mixed multinomial logit (MMNL) parameter model. For calculation of WTA, we used both population-level parameters and individual-level parameters. RESULTS The mean WTA for an additional hour of informal care, corrected for positive and negative impacts of informal care, was €14.57. The signs of the coefficients were all in the expected directions. CONCLUSIONS This study reports a preference-based monetary value for informal care, corrected for other impacts. This valuation facilitates the inclusion of informal care hours on the cost side in economic evaluations without double-counting any spillover effects included on the effects side.
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Affiliation(s)
- Renske J Hoefman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Werner B F Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Bibbo J, Rodriguez KE, O’Haire ME. Impact of Service Dogs on Family Members' Psychosocial Functioning. Am J Occup Ther 2019; 73:7303205120p1-7303205120p11. [PMID: 31120842 PMCID: PMC6533052 DOI: 10.5014/ajot.2019.031690] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE A growing body of evidence supports service dogs' positive psychosocial impact on people with a chronic condition, but very little is known about the effect of service dogs on the family members with whom they live. OBJECTIVE To measure the impact that a service dog may have on family member functioning. DESIGN Cross-sectional with a single time-point assessment. SETTING Data were collected via a self-report survey completed online, over the phone, or by mail. PARTICIPANTS Potential participants were recruited from national service dog provider Canine Assistants. Participants were caregivers or spouses of a person with a disability or illness who either currently had a service dog (n = 51) or was on the waitlist to receive one (n = 77). Participants were 50 family members (46 parents-caregivers and 4 spouses-partners) living with a service dog and 76 family members (68 parents-caregivers and 8 spouses-partners) whose family member was on the waitlist to receive one. OUTCOMES AND MEASURES Participants completed standardized measures to quantify psychosocial health and functioning, health-related quality of life (HRQOL), and family functioning. RESULTS Living with a service dog was most closely associated with less health-related worry and better overall psychosocial health and emotional functioning, less total family impact from the chronic condition, and better emotional HRQOL. CONCLUSIONS AND RELEVANCE These findings provide preliminary evidence that, in addition to having an impact on recipients, service dogs can affect several aspects of family members' psychosocial health and functioning. WHAT THIS ARTICLE ADDS This research demonstrates that the impact of a service dog may extend beyond the recipient and have positive impacts on family members' psychosocial functioning as well. Occupational therapy practitioners should include family members in discussions regarding the integration of a service dog into the home and recognize the potential for family-wide effects from the service dog's assistance.
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Affiliation(s)
- Jessica Bibbo
- Jessica Bibbo, PhD, is Research Scientist, Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, OH. At the time of this research, she was Postdoctoral Research Fellow, Center for the Human–Animal Bond, Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN;
| | - Kerri E. Rodriguez
- Kerri E. Rodriguez, MA, is Doctoral Candidate, Center for the Human–Animal Bond, Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine
| | - Marguerite E. O’Haire
- Marguerite E. O’Haire, PhD, is Associate Professor, Center for the Human–Animal Bond, Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine
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Elrod JK, Fortenberry JL. Establishing Good Samaritan programs in healthcare institutions: a method for enhancing patient experiences and increasing loyalty. BMC Health Serv Res 2018; 18:927. [PMID: 30545346 PMCID: PMC6293488 DOI: 10.1186/s12913-018-3677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare institutions deliver essential services that practically everyone needs at least periodically over the course of their lives. Hospital admissions, in particular, place patients in circumstances very foreign to them, with uncertain outcomes often being the case, causing stress for care recipients and their loved ones. Health and medical establishments must be very mindful of this and work toward supplying environments that are as comforting as possible for those in their care. Discussion One avenue for relieving patients and their loved ones of hardships that complicate already difficult situations involves the development and implementation of Good Samaritan programs. Termed in reference to the biblical Good Samaritan who attended to the physical and emotional needs of his neighbor, these programs supply aid and comfort over and above that which traditionally has been delivered to patients in healthcare delivery settings, fostering satisfaction, positive word-of-mouth communications, and loyalty. Willis-Knighton Health System operates a Good Samaritan program, notably including a patient concierge team, complimentary lodging, and free transportation, with the offering greatly improving the patient experience. This article profiles Willis-Knighton Health System’s Good Samaritan program and supplies a blueprint for establishing similar offerings in virtually any healthcare entity. Conclusions Good Samaritan programs provide significant support and assistance to care recipients and their loved ones at particularly difficult times. Willis-Knighton Health System has observed firsthand the many benefits afforded by its Good Samaritan program, relieving those served by the establishment of many burdens and endearing them to the institution for its associated investments which foster peace of mind.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Hartill E, Gillis R, Imran Jiwani S, Recchia N, Meal A, Adams G. Hypoglycaemic unawareness: A systematic review of qualitative studies of significant others' (SO) supportive interventions for patients with diabetes mellitus. Heliyon 2018; 4:e00887. [PMID: 30417151 PMCID: PMC6218670 DOI: 10.1016/j.heliyon.2018.e00887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/11/2018] [Accepted: 10/23/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hypoglycemia unawareness (HU) has been attributed to both a downward shift in central nervous system (CNS)-triggered sympatho-adrenal responses to low glycaemic thresholds and a subsequent loss of adrenergic symptoms, which, in addition, to cerebral cortex adaptations permit normal function under hypoglycaemic conditions. Both of these mechanisms are brought about by recurring hypoglycemic events (hypoglycemia-associate autonomic failure, HAAF). This can contribute to repetitive cycles of increasingly severe hypoglycaemia, the consequences of which have considerable impact on relatives and significant others (SO) when providing care to patients with diabetes. METHODS A Systematic Review (SR) of 639 qualitative studies was carried out in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. The search strategy was developed using MeSH terms for a range of electronic databases: CINAHL, Pubmed, EMBASE, Medline, AMED and ASSIA were systematically searched in order to identify a variety of literature relevant to the review topic. Four duplicate studies were removed and a further 630 studies were excluded due to being irrelevant. Five qualitative studies were retained and analysed. RESULTS The three resultant findings from the literature appraised were i) Experiences and views of Significant Others' (SO) with adult relatives that have HU ii) Support needs of SO and iii) Health professionals interventions to address SO support needs and improve overall HU care. A clear finding was that SO experience difficulties managing HU and this can impact on the relationships that SO and HU patients have. Support needs of SO highlighted were both educational and psychological in nature, with there being a requirement for additional raised awareness within the wider community. CONCLUSION It is essential that healthcare professionals offer support, such as teaching and support groups. In addition, providing interventions into improving family knowledge of diabetes and support with regard to psychosocial, behavioural and practical support for the person with diabetes. Moreover, improving resources for families to improve diabetes care. However, as the literature was of a qualitative nature, future recommendations would be quantitative research into these suggested nursing implementations to quantitatively assess their usefulness in practice.
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Affiliation(s)
| | | | | | | | | | - G.G. Adams
- The University of Nottingham, Faculty of Medicine and Health Sciences, C Floor, South Block Link, Queen's Medical Centre, Nottingham, NG7 2HA, UK
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Evaluation of depression in patients with alzheimer's disease according to the location of medical care. Arch Psychiatr Nurs 2018; 32:688-694. [PMID: 30201196 DOI: 10.1016/j.apnu.2018.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/09/2018] [Accepted: 03/11/2018] [Indexed: 11/22/2022]
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